Cycling Aches & Pains, Part 1: A Pain in the Butt

I went to the ER at Mercy Medical in Durango, Colorado, less than 1,000 miles into the 1996 Race Across AMerica. They peeled down my shorts, looked at my butt and said, “Your race is over. You have second-degree burns on your buttocks.”

A second-degree burn is through the epidermis and into the dermis, the thick layer of tissue that forms the true skin. I didn’t care what second-degree meant, all I knew was that it hurt like hell!

The day before it was 108F (42C) and I was racing across the desert down on my aerobars with a great tailwind. Concerned about saddle sores, I’d put a black gel-filled saddle pad on the bike. The pad heated up and literally burned my butt!

While it was definitely an unusual way to be afflicted, I was certainly in good company as a road cyclist suffering from saddle-related discomfort.

Saddle Discomfort/Sores the No. 1 Roadie Affliction

The Question of the Week posed on September 15 was, “What is the Biggest or Most Common Physical Issue that Affects Your Riding?” RBR readers responded:

Saddle Discomfort / Saddle Sores – 135 votes, 20.5%

Upper Back, Shoulder, Neck Pain / Discomfort – 115 votes, 16.8%

Numb / Painful Hands – 108 votes, 15.9%

Something Else – 97 votes, 14.6%

Lower Back Pain / Discomfort – 77 votes, 11.5%

Cramps – 74 votes, 11.0%

Hot / Painful Feet – 62 votes, 9.1%

Nausea – 3 votes

In recent columns I’ve already discussed cramps and nausea because of inquiries from individual readers. Today, I describe the various types of butt problems, how you can avoid them and what to do if you suffer from saddle pain during a ride. Future columns will discuss the other problems.

Butts Are Like Faces!

Riders’ butts (and sitting area, in general) are as different as riders’ faces. This column discusses the general types of problems, causes and solutions to sitting-area afflictions. If you suffer from pain in the nether region, hopefully you can use or adapt one of these.

Types of Saddle Sores

Saddle sores develop in five different ways, several of which may occur at the same times:

Sitz bones. Pressure on your ischial tuberosities (sitz bones, see photo) reduces blood flow to the skin, depriving the skin of oxygen and nutrients, resulting in pain. In one study of amateur endurance
cyclists, over 70% of the seat-related discomfort was due to pain around the sitz bones.

Chafing. Friction between the inner thighs and groin and the saddle causes red, inflamed skin breakdown.

Crotchitis and crotch rub. Crotchitis is a group of skin problems in the groin that can cause great pain in a female cyclist’s life. Crotchitis is basically a form of diaper dermatitis between the vagina and the anus, a red, tender, itchy, eczematous rash. This condition is almost always compounded with a yeast infection, and almost always responds to steps to maximize dryness while riding and medication to kill yeast.

Folliculitis and furuncles. Folliculitis is an infection at the base of a hair follicle, and a furuncle, or boil, is a collection of pus, an abscess. These infections usually occur in the groin.

Skin ulceration. If the outer layer of the skin is damaged, bacteria may enter and infect the deeper layer of skin, forming an abscess.

Mercy Medical was concerned that my second-degree burns would get infected. I went twice a day for a week to soak my butt in an antiseptic bath.

How can you avoid problems?

Bike fit — The first step in avoiding pain in the butt is a good bike fit:

Your weight should be properly distributed between the saddle and the handlebars. With your hands on the brake hoods your torso should form about a 45-degree angle with the top hood.

Your saddle should be at the right height so that your hips aren’t rocking, which causes friction.

If one hip drops more than the other hip as you pedal, then that leg may be shorter than the other one, making that side of your butt more prone to pain.

Saddle choice — Because your butt is individual, your saddle should be the right one for you:

It should be the right width so that your sitz bones are supporting you, not your crotch. Specialized makes a tool to measure the width of your sitz bones (see photo, above). Also take a look at John Marsh’s Interbike article today about a new totally custom saddle maker, which takes an impression of your sitting area in foam that it uses to make your body-specific saddle.

The curve between the nose of the saddle and the broader part you sit on should accommodate the width of your thighs. Although a wider saddle may seem more comfortable for the butt, it will increase friction.

It may have a cutout. For women, a cutout may reduce problems with abraded soft tissue. A cutout may reduce pressure for man who is developing an enlarged prostate.

It should be lightly padded if your problem is pain under your sitz bones. However, heavier padding will allow your butt to rock, causing friction.

It should be smooth enough so that you slide easily without friction.

Get the saddle that fits you, rather than a lighter one. Even if it’s a heavier saddle, pain-free riding will let you ride more, have more fun, and get fitter!

Folliculitis — is an infection in the groin, which is relatively painless and usually heals without any problems.

Furuncle — looks and feels like a pimple and is usually painful. If untreated it can become extremely painful. See your doctor.

Skin ulceration — the outer layer of the skin is damaged, bacteria may enter and infect the deeper layer of skin, forming an abscess. See your doctor.

Cleanliness — Wash yourself and your shorts after every ride, and if you are using a lubricant, wash it off thoroughly. If you still have an expensive anti-bacterial, soap throw it away — the FDA recently banned them because they do more harm than good. Bacteria are normal on the skin and will migrate back after you wash anyway.

Butt it still hurts!

If in spite of trying the above remedies to your particular issue – and having no success – what can you do if you still develop some sort of butt pain?

Lubricate it — if you’re developing a friction sore, use (more) lube; however, all the lube in the world won’t deal with pain under your sitz bones.

Pad it — A bunion pad may protect a tender spot under a sitz bone.

Persevere — A sore butt doesn’t have to be a showstopper. After burning my buttocks I have a permanently tender butt. I’ve learned to use my mental skills to finish many rides despite saddle sores!

Numb it — Lidocaine is a generic over-the-counter medication used to numb the skin. I’ve used it on ultra rides when quitting wasn’t an option. It’s also known as xylocaine and lignocaine. Look in the pharmacy section for treating hemorrhoids.

See your doctor — If you develop a furuncle or skin ulceration, see your doctor.

By following the steps above, almost all saddle sores can be prevented.

Next week, I’ll discuss discomfort or pain in the upper back, shoulders and neck.

Coach John Hughes earned coaching certifications from USA Cycling and the National Strength and Conditioning Association. John’s cycling career includes course records in the Boston-Montreal-Boston 1200-km randonnée and the Furnace Creek 508, a Race Across AMerica (RAAM) qualifier. He has ridden solo RAAM twice and is a 5-time finisher of the 1200-km Paris-Brest-Paris. He has written nearly 30 eBooks and eArticles on cycling training and nutrition, available in RBR’s eBookstore at Coach John Hughes. Click to read John's full bio.